The University of Wyoming’s Family Practice Residency in Casper and the
residency in Cheyenne have been examined by The Wyoming Department of
Health. The Department of Health released that study this week to the Joint
Appropriations Committee of the Wyoming Legislature in Casper on Monday.

By Tom Lacock
Wyoming Medical Society

CHEYENNE – The Wyoming Family Practice Residency Program was examined by the Wyoming Legislature’s Joint Appropriations Committee (JAC) last week in Casper. The residencies were studied by the Wyoming Department of Health at the direction of the Wyoming Legislature. The JAC took the report and did not make any calls for action at this meeting.

The hope was to answer the questions of the core purpose of the residencies and whether that purpose is that still valid. The report said In terms of achieving the core purpose stated above, results are mixed. Generally speaking, the residencies are:

Less efficient than other clinics at delivering primary care services;

More efficient than most other residency programs at training physicians;

Improving in quality, though still slightly below the national average; and,

Poor at retaining its graduates in-state.

The report added the Casper site performs better than the Cheyenne site in all of these areas. The Wyoming Department of Health used graduation rates and board passage rates as its quality measures for the study. Casper residents passed their certification exam rates at 94 percent passage rate from 2011-2015. Cheyenne’s passage rate was 79 percent. Over the same period the Wyoming residents scored lower on the Family Medicine Certification Exam than their colleagues, posting an average of 460 versus a national average of 492.

The concern from the legislature seems to be whether the state funding for the residencies is properly placed during a time of reduced state budgets. Franz Fuchs, who presented the study on behalf of the Department of Health said the residencies offer two services – training doctors and providing primary care costing around $17 million per year with $9.8 of that coming from the state’s general fund. The clinics offset part of that with around $5.4 million in clinic revenue. Unlike some residency programs, the UW Family Practice residencies are not attached to hospitals making some Medicare funding unavailable.

Fuchs added that the clinics at the residencies are not offering subpar care at all, adding that the client rolls of the residencies contain 22 percent uninsured patients. Another 20 percent of residency clients were Medicaid clients, with another 20 percent being covered by Medicare.

According to the study, there are 106 University of Wyoming Family Practice Residency program graduates still practicing in the state. Natrona County leads the state with 33 residency grads still practicing in and around Casper, while 24 residency graduates are in Cheyenne, and another eight in Fremont County. Over a 30-year average the state is reporting just 23 percent of residency graduates’ “doctor-years,” are likely to be in Wyoming.

The national average according to a national study for the years 1970-2006, for graduates who perform their residency training and then stay in that state is 56 percent. In that study, Wyoming ranks above only Rhode Island, and the District of Columbia for retention of in-state residents. California, Texas, and Mississippi all had retention of 74 percent or higher for the same period.

The Department of Health added the per-graduate cost to the state to train residents of $407,000, the number averages $1.77 million when you consider just the residency graduates who have stayed in-state.

Department of Health Director Tom Forslund said his agency tried to offer an overview without recommendations.

“The Department of Health did not make recommendations,” Forslund said. “We didn’t think it was in our charge to offer them. Instead we have offered some options to consider.”

The decision tree that The Department of Health offered included with the report sought to answer the questions Is “building” physicians (though residencies), for example, still the proper role of the State? Or would “buying” them be more appropriate (through loan forgiveness)? Or merely providing primary care?

The options the Department of Health offered included:

Close the residencies, revert all funds used by the state in running of residencies to the state’s general fund;

State funding of indigent primary care;

Recruiting/loan repayment contracts;

Moving administration for the residencies to a hospital;

Find another non-state entity to move administration of the residencies to;

Close the Cheyenne residency and consolidate with the Casper residency;

Look for operational efficiencies;

Look into residency expansion potential.

Fuchs said the residencies were board in the peak of a doctor shortage in the 1970s with the Casper site coming online in 1976 and Cheyenne in 1979. At the time, the residencies were part of a discussion that included possibilities such as whether it was feasible to even begin a medical school at the University of Wyoming? One of the concerns for keeping the residencies in place is the fact the number of residency slots paid for by Graduate Medical Education and the federal government has not increased since 1997.

The study also offered positives for the program. It noted the residencies have contributed up to 40 percent of Wyoming’s family medicine practitioners, though currently that number sits closer to 30 percent. Fuchs also pointed out the residencies do not provide subpar care to clients, just slightly below average for pass rates and board certifications.

The residencies had several advocates at the meeting who testified on its behalf, including Residency Board Member Ann Rochelle, who pointed out to each member of the committee which physicians in their community arrived through the residencies. She admitted that productivity in the Cheyenne clinic could be better and said the residencies will continue to work on that. She added that other residency programs are hosted by hospitals, while the Texas Medical Association administers a residency program in Texas.She wondered aloud if it is time to consider other avenues other than the University acting as administration.

University of Wyoming Spokesperson Meredith Asay suggested the University is working with the Governor’s office and the UW president and has reached out to a rural health medical education expert. She said that group may come to Wyoming to advise the University on medical education expenditures.

The study also shows faculty at the residencies making far less than their colleagues at other residencies with the biggest differentiation coming among the faculty who can make up to $30,000 a year less than the national average. Residents in the program are paid around $55,000 per year.